The Wonders of Bali: Those F*cking Monkeys!

After a busy last week of analyzing data and putting together a presentation for the Jhpiego Indonesia and USAID staff, I finally let out a sigh of relief and headed to Bali. I actually had a problem with my visa and had to make a choice of going home 10 days early or going to Singapore for a day and re-entering Indonesia to get a new passport stamp. In the end, I decided to go to Singapore so that I could have my vacation in Bali, but being here is a bit lonely. That said, I'm here, I'm relaxing, I'm exploring and all is well.

Before I came to Indonesia, I met a woman who often travels to Bali and we instantly hit it off. Since I've been here, she's been putting me in touch with her friends in/around Bali. One of these wonderful friends, Liza, offered to let me stay at her house and use her motorcycle (which has been awesome, not only for the company, but also for saving money!). She actually lives in Jimbaran, a place in Bali that has very expensive hotels, but is very quiet and relaxing and that sounded like a place I wanted to stay. So, it's worked out perfectly. She picked me up at the airport on Sunday night and gave me a tour of the very popular/touristy areas of Kuta and Legian. I was kind of tired, but without this tour I would have had no idea of where to go throughout the week, so it turned out to be extremely helpful. We then went to a warung (food stand), on the beach, that served fresh seafood - heaven! - and I ordered giant shrimp/prawns. They were grilled and delicious and I will likely dream about them for days to come.

Distant view of Ulu Watu temple, the cliff and the loud breakers crashing against the cliff.

Ulu Watu Temple

The following morning brought about Exploration Day #1. When I go on vacation, I definitely like to explore. There are usually gorgeous sites to see and its a shame to come all this way just to laze on the beach. I actually planned to go to the beach on Monday but as I started out on my moto, the sky was overcast and I thought maybe it would be better not to. So I headed south to Ulu Watu. In general, the whole southern tip of Bali is called Ulu Watu, but there is in particular a Hindu temple that sits on a cliff overlooking the water. I arrived at the temple, parked the moto and paid my admission fee. The old men at the admission counter warned me to take my sunglasses and earrings off and then pointed to a sign to emphasize this. The sign said something about monkeys and then an old man offered to accompany me with a stick to keep the monkeys at bay. I politely declined. So I took my earrings off and put them in my pocket, but not my sunglasses. It was midday and so bright, I wouldn't have been able to see anything. I started up the stairs to the temple and as I reached the top, a path led off to the right along the edge of the cliff. I started off that way and saw some gorgeous breakers crashing against the rock and saw a beautiful pagoda and thought, "When I finish walking around, maybe I'll come sit here and read for awhile." I returned along the path to the actual temple and while walking up the stairs a whole family of monkeys was walking toward me. I dismissed this, but at one point turned around to see two baby/kid monkeys playing (photo below).

The two monkeys I photographed as I lost my sunglasses.

I hate this monkey.

As I stopped to take their mid-action shot, I felt a scratch on my face as my sunglasses were literally ripped off my head. So shocked, I turned around and saw a monkey sitting on the wall with my sunglasses in hand. I immediately thought I might be able to get them back to started walking toward him. He outsmarted me by moving much quicker than I could and then jumping into the nearby tree. I knew all was lost. I didn't think much of it because they were just sunglasses, but like I said, it was midday and really bright. As I started to think there might be a chance I could find someone to get them back, the monkey started chewing off the nose pads and spitting them onto the ground. I hung my head in disappointment and continued walking up the stairs. Monkey 1, Sara 0. Adding insult to injury, a group of Japanese tourists and their guide passed me walking down the stairs and saw the monkey with my sunglasses and started laughing. F*cking monkey.

The idyllic pagoda I hoped to sit under and read.

I made the rest of my visit brief. The temple was beautiful, bust most of it closed off to tourists. I walked around the other side and along the path leading the opposite direction that I had just come and on my return I stopped to take a look at my Lonely Planet. I wondered if there was anything else to do in the area, other than the temple. As I stood, my backpack resting on a large table of sorts, a fat monkey stole the flip flop of an Indonesian woman in front of me. In order to get it back, one of the guards had to give the monkey some fruit. The monkey seemed content with the fruit but as I was flipping through LP, he reached into my bag and pulled my wallet out. With cat-like reflexes, I hit him with my book and grabbed my wallet. He tried to bite me and people were yelling, "Take your bag, take your bag." WTF? At this point, I was DONE with Ulu Watu temple and these god forsaken monkeys. I later learned, not surprisingly, that the people at the temple train them how to steal things. And these trainers can get your things back for you, but not without a fee. In my worst moment, I saw this fat monkey unzipping my wallet and emptying it's contents - bills, both Indonesian and American, coins, photos, pens - and having a party. Great start to my vacation in Indonesia!

He looks so sweet, eating this sweet rambutan. Until he tries to steal your wallet...and then bite you.

Cove at Ulu Watu Beach.

After the temple, I headed down to the beach. It was really only a surfers beach, but it was gorgeous. There were about 100 sand covered steps to get down there, and with my fear of falling up or down stairs, I took my time. The small cove at the bottom of the stairs was so unexpected and so beautiful that I was happy I made the journey. I know nothing about surfing, but the surfers here seemed to be very happy and the waves looked incredible. I thought about trying to find a place to lay out, but with no luck I turned around and headed back to my moto and back to Jimbaran.

The sun was out now and I wanted to lay out and read Harry Potter, but I didn't want to stray too far from where I was. The night before we had passed some very nice hotels that I knew must have awesome swimming pools, so I stopped by the InterContinental, one of my favorite hotels in the world. By simply telling the security staff I was meeting someone, I was able to sneak in and have some pretty luxurious R&R. The chairs around the pool were plush, there was a swim up bar in the pool, and the beach was just a few steps away. Of course, the almost $10 milkshake I bought shook me back to reality, but it was nice while it lasted. Finally I headed up to Legian Beach to have an Italian pizza dinner and watch the sunset. With the exception of the monkeys and the lost sunglasses, it was a pretty good first day.

My stolen view at the InterContinental

Sunset at Legian Beach.

Serang, West Java

Sign for Midwife Ratini, next to the poskesdes.

Mother's waiting their turn for an interview.

Group photo in front of the poskesdes - including the village midwife and the village health workers.

An early morning was the beginning to our last field visit, Serang. I can’t say that waking up at 4:30 and leaving at 5:15 was my ideal travel schedule, but knowing that I was one day closer to being finished with these interviews was motivation enough. Don’t get me wrong, the interviews have been fascinating. But after conducting 230 of them, and knowing that we have between 60 and 70 to go feels great. It’s been a frustrating past two weeks and our past two sites have been difficult. I dozed between Jakarta and Serang, normally a two hour trip but it only took us an hour and half since we left before there was any traffic. We arrived at what I would later realize was the MCHIP office and I was eagerly greeted by many “hellos” which confused me as I was waking up. After walking into the office and barely noticing the MCHIP sign on the wall, everyone interrupted a conference call with the States (which I can totally imagine being in the States on that conference call and being like, “what in the world is going on?”) to greet me and I sunk into a leather loveseat and listened to their workplan for the month of July. The MCHIP team in Serang is supported by John Snow, Inc., which I’ve heard great things about! The project manager/leader is actually a dentist by training, and the entire team is very well organized. At 8 AM, we headed to the District Health Office to meet the Director and discuss our purpose for being in Serang. Since he had already received the official letter from MCHIP, he told us that he was really pleased that we were doing this research. He then, unlike any other DHO has done, explained to me that in Serang – and much of West Java – culture and traditions play a huge role in people’s daily lives. Many women want to stay home to be comfortable and surrounded by their families, including grandmothers and grandfathers, to deliver their babies. While there has been a shift toward using more midwives than TBAs, TBAs are still very present at the village level. This was a nice backdrop to have before beginning our interviews. He also acknowledged that the results of our research will be very important for future planning in the district. Yes, another district that cares and wants to use the results to put into action! After our meeting with the DHO we left for Barugbug.

Our drive began through the city where Isti pointed out good salons and restaurants to dine at. She previously spent two months here with another midwife volunteer who worked on training midwives. We continued, me not really caring about my surroundings. After maybe 10 km, or so, we turned off toward Barugbug and the entire landscape changed. All of a sudden we were surrounded by banana and palm trees and small houses on the side of the road. After a few km, a mountain appeared through the morning mist/haze, and I looked around confused, thinking, “Wasn’t I just in the city?” I felt like we fell into a totally different dimension of the district we were in. We arrived at the Padarincang puskesmas and picked up the midwife coordinator before heading to Barugbug. We retraced the road that we had just taken and turned left down a narrow and steep alley. The “road” soon became a horrible mess of rocks and a previously paved road. We traveled through a small village until we reached a stream and a bridge. After crossing the bridge, the landscape again changed full of green rice fields and tall palm trees and mountains in the background, one one side, and a badly polluted stream on the other. I finally felt that I had found the Indonesia I was looking for. Where has this quaintness been in the past six weeks? And why did it take until my last field visit to find it? Admitedly, I’m happy that Serang wound up being our last field visit instead of our first. If this landscape had been my first day of field visits and the rest had gone downhill, I would have been really disappointed. Though, Minas was really nice, it was just all those oil pipelines that ruined the scenery for me. I digress….

Woman walking along the road from the rice fields back to the village

The bright green grass and mountainous - ok, hilly - scenery surrounding what I presume to be a resting area/hut in the middle of the rice field.

When we arrived at Barugbug, we went to the poskesdes where a posyandu had just ended. It took us a few minutes to get set up because the midwife was still administering vaccinations, so I eagerly took out my camera and started shooting mothers and babies. It wasn’t long before I was called in to start interviewing though. We interviewed 13 women today and it took almost four hours. This after our last day of interviews in Bojonegoro was 12 women and only took two hours. It was a challenging day for us, and the beginning of what will likely be a challenging week. The education system in West Java must be terrible compared to the two other regions we visited. We have one question, that depending on the context, asks women why they chose to deliver where they did or what might encourage them to deliver at a facility, and we offer them a list of 15 possible choices. We definitely ran into some problems when we started our interviews because the list was difficult to understand. For example, one of the options is “Distance” but this means different things if you’re choosing to deliver at home because you don’t have to go anywhere or if you’d be encouraged to go to a facility if it were closer. After experiencing these difficulties (mainly in West Java) we wrote out very clearly what the options meant for both a non-facility and facility response. Despite making it as clear as possible and having had no problems in the last 70 interviews, we find ourselves again in West Java where the women get confused and flustered by the list and many cannot even read the options or understand what they mean. This makes our research really challenging because technically we’re supposed to ask every question the same way. But when someone doesn’t understand the question, are you just supposed to pass it by? So we kind of danced around these questions today and tried to come up with a plan for making sure these women understood the question. What’s even more frustrating is when the women clearly do not understand the question, and just start naming off responses. I’m not sure why they don’t say, “I’m sorry, I don’t understand this question, can you please explain it better?” - we encourage them to ask questions if something isn't clear. It must be pride, but their pride is ruining my data! An example of this, from today, is a woman saying that she would be encouraged to go to a facility because she knows it cleaner than delivering at home. But in the next question, asking if she would recommend to her friends/family to deliver at home, she says yes and then cites cleanliness at home, to support her recommendation. These situations make for a really long day, especially when we’re used to these interviews taking 9-12 minutes and they are drawn out to 15-20 minutes. Doesn’t sound like a huge change, but since I can’t jump in and say, “Okay, this is what we’re trying to say…” I get frustrated as well. That said, I was just really happy to be sitting in this idyllic village and these issues weren't affecting me like they had before (I will write more about what happened in Kawawang).

Mothers and babies.

More mothers and babies.

We had some interesting stories today, which isn’t necessarily the case every day. I can imagine that since we’re in a region that has such strong ties to culture and tradition, that the experiences of women here will surprise me a little every day. The majority of women that we interviewed today delivered at home, either with a TBA or midwife. Two of the women had prolonged labors. One young woman, 20 years old, was in labor for three days before the TBA finally referred her to the puskesmas. Three days? I’m curious what the TBA thought after the first 24 hours - did she think she had a solution to the labor? And what about 48 hours? Another woman, pictured below, is 46 years old and has eight children. Her latest birth was a few months ago and she spent five days in labor. What? Five days? On her fifth day, with no hope in sight of delivering this baby, the imam at the mosque came to her house and told her that she must have a ghost around her which was prohibiting her from delivering her baby. He gave her some “holy water” – I don’t know what it’s called in Islam – and she miraculously delivered her baby the same day.

46 year old woman, pictured with four of her eight children. She survived five days in prolonged labor.

Our first interview of the day.

The only issue I take in all of this is wondering if the TBAs and village midwifes are really upholding their oath of protecting women’s lives and ensuring their safety by getting them the services they need when they need them. I was told, “Well, maybe the women don’t want to go to the facilities.” In my opinion, it’s the responsibility of the TBAs and midwives to inform – and even possibly force – these women to get to the facility to deliver their babies before three or five days pass. I’m amazed that after five days in prolonged labor that this woman didn’t die. These are the instances that I wish culture and tradition weren’t so strong and that TBAs and midwives could say, “You’re going to die if you don’t go to the hospital” in order to make these women realize how grave their situation is.

I was sitting behind the window to this boys right, and he and other young children kept playing peek-a-boo with me. To win their hearts over, I take their pictures and then surprise them by showing them their photo on my camera. It works, almost, every time.

I loved this baby who, though asleep, looks so distressed with her little hand covering her face.

A young girl who thought she was afraid of me until I took her photo.

Mount Bromo - my first volcano!

My first bit of tourism in Indonesia was visiting East Java's Mount Bromo. I'll let the photos - albeit bad photos - tell most of the story, but there's always a story! Since we don't work on Sundays, but we were in East Java, we drove six hours from Bojonegoro to Probolinggo, where most visitors start the assent to Mount Bromo. We left Bojonegoro on Saturday around 12:30, meaning we wouldn't arrive until after dark. If there's one thing I learned in Peace Corps that I will never forget, it's not to travel at night in developing countries. There are rarely street/road lights, you can't see anything, and many cars and motorcycles aren't in good working condition, i.e. front head lights. We arrived in Probolinggo right around sunset and started driving up the mountain. At first it wasn't so bad, but as the night set in - as it does early here in Indonesia - and the sky became pitch black, it became harder to see where we were going. Pitch black countryside, with the exception of our headlights and winding roads all the way up to 2,000 meters. It was the first night I've seen the stars in Indonesia, maybe one of the only places in the country where there's no light pollution (I'm exaggerating, but not much). As we were driving, and the endless road became steeper, I was comforted by the fact that it was dark and I couldn't see anything. I imagined that the drive down the next day would be lovely though. Though there are many hotels to choose from, we chose to stay at the hotel closest to the volcano, which would mean a shorter time in the morning to get to the top for sunrise. When we got out of the car it was cold, but it wasn't that cold. To see Indonesian's bundled up in parkas, scarves, hats and gloves was a sight. And the way they all huddled together to keep warm was funny. After we checked in we headed to the lodge, the restaurant and general hang out area. I felt like I was at a ski resort, except there was no snow and I was wearing sandals. Standing outside the entrance to the lodge were vendors of wool socks, scarves and hats. The guide books say that it can drop to between 3 and 20 degrees Celsius and it was recommended to me that I rent a coat to wear. I brought the only warm clothes that I brought to Indonesia: two long sleeve tshirts, long pants and sneakers. If it were for the fact that we were planning on going up the mountain at 4:00, I probably wouldn't have rented the jacket, but I didn't know how cold it might be that early. So I spent the $3 to ensure my warmth.

Sunday morning we woke up at 3:30 and hopped in an old school Land Cruiser to make our way up the mountain. Before we got in the car, there were again vendors selling their usual wares, but now selling those surgical-like masks that people wear when they're sick or have Bird Flu. All I thought was, "What? Really?" I would later regret my casual walk by the surgical masks en route to the car. Considering we were as far up as one could go without these 4X4's, the drive only took maybe 15 minutes. On the dusty road we passed people on foot and horses bringing people up. Once we arrived as far as we could go, we had to get out and walk the rest of the way. The walk up consisted of a windy, dusty path, full of people and horses carrying those up who couldn't/didn't want to walk. After you got to a certain point, the horses couldn't go any further and there were stairs to climb the rest of the way. It was a brutal climb because everyone and the horses were kicking up so much dust - I finally realized what the masks were for. I later realized that this dust was actually ash from Bromo. I immediately had dust in my nose and my mouth and I could feel it between my toes.

When we finally got to the top, it was maybe 4:00 AM and pitch black, with nothing to see or do but wait. Isti wasn't able to make it up, so I went with some random guy who happened to stop at the same time we stopped and she said she couldn't continue. As usual, big mistake. The only good/use that this guy was was telling me which direction the volcano was, otherwise, I would have been staring at the side of the mountain waiting for some excitement. The bad thing was that he thought I was his best friend and was clinging to me like a fly. At one point, these two women from Korea were trying to take self photos and I offered to take their photo in exchange for them taking mine. As I posed for the photo, this guy jumped into the photo, as you'll see below. I'm too nice and too worried about looking like an obnoxious American to have pushed him off the ledge, though the thought was there. Anyway...as the sun rose, I tried to take some photos of the gorgeous landscape, the mountain side below and some other mountains in the distance. The cool thing though was once the sun rose enough that we could see the volcano and the ash coming out of it, everyone was captivated. Over the next hour or so that I spent on this mountainside watching the volcano, it "erupted" 2 or 3 times, which was pretty cool. Each time the ash cloud formed a new shape before it dissipated. Another volcano, in the distance also emitted a small cloud of ash, as if to try and steal the show from Bromo.

After awhile I started my way down to meet Isti and continue back to the hotel. I was told that the price we paid included a trip to the Sea of Sand, that surrounded the base of the volcano, but that since the volcano was active that we couldn't walk up to the top. Whoa, who said anything about walking to the top? I had no idea that was even an option. The Sea of Sand didn't sound to thrilling, but we went anyway and started walking toward Bromo. Turns out that people were walking up to the lip of the volcano and once the guide and I started walking I was ready to go to the top! In the end, we wound up not walking all the way up and instead turned around to go back to the hotel.

Landscape at sunrise

First view of Bromo with a cloud looming overhead.

My faux best friend, me and Bromo. Can we photoshop him out?

A new burst of ash from Bromo

Long line of Land Cruisers who ushered their guests to the mountain. Luckily we got there early enough that ours was at the top of that long line.

Bromo's jealous cousin emitting his own ash

Third new puff of ashThird new puff of ash

The Sea of Sand - there's a Hindu temple down there at the base between both mountains, but you'll have to click on the photo to see.

View from midway up the volcano, over the sea of sand and to where we stood earlier for the sunrise.

People climbing to the rim of Bromo. I will say that about 30 minutes later, as I was sipping my hot tea in the lodge, Bromo erupted again. This also happened about 30 minutes after that. I'm sure everyone was fine, but with the amount of ash I already had in my nose, I was kind of happy we didn't go all the way up.

View of Bromo from the Sea of Sand

Our car, covered in ash from Bromo

The gorgeous view on the way down winding roads of the mountain

We left Bromo around 9:30 to head back to Bojonegoro. All in all, it was a pretty good trip, if not a quick one. I had ash in my mouth, nose and ears for a few days after and I still have ash in my sneakers that finds its way between my toes when I'm running. It was certainly exciting to see the volcano, but I missed having an adventurous friend there to climb to the top and to take ridiculous jumping photos.

How long is too long? Or too short?

I’m at the midpoint of my summer internship and I’m having mixed feeling about…well, everything. It’s been a month and I’ve accomplished a lot, in terms of interviewing women, collecting research and visiting several different sites, but I feel like I’ve accomplished nothing in terms of integrating and adapting to Indonesia. There are definitely some reasons I can identify as to why I feel unaccomplished, but I’m sure there are other reasons that aren’t making themselves too evident:

• I had assumptions and expectations – someone once told me that making assumptions was the dumbest thing you could do (maybe not in those words, but that’s what she meant). Ever since then, I cringe when I’m talking to someone and I say, “Well, I assume it was because….” because I wonder if they’re thinking, “wow, she’s making assumptions – not smart.” But then I remember that everyone makes assumptions. I didn’t realize that Indonesia was as developed as it is and I didn’t really grasp that there were 200 million people here. I mean, how can you really know what 200 million people feels like, when the largest population you’ve lived amongst was 500,000?

• I also expected things would be a little different than they are. I don’t really feel like I’m doing a ton of physical work, since I’m not doing the interviewing, but rather listening to 12-15 interviews a day in Indonesian and then circling the women’s responses on my questionnaire. I suppose interviewer fatigue has set in. I know I’ll have a ton of work to do analyzing the data and writing my report when all is said and done, I just wish I was a little bit more involved in the day to day. I also thought (though I don’t know why) that I’d be involved in coordinating things, and since I’m not and have really no control over the coordination of our day to days, it gets annoying when things don’t go right. Everyone seems very laid back about the research I’m doing, but I feel very protective of making sure that everything’s perfect since I’m planning on using the data for my master’s paper and hoping to publish or possibly submit for Global Health Council. It’s frustrating to think that you’re on the same page with someone and constantly get questions like, “So, what do you want to do?”

• I constantly compare everything to Mali – I love Mali, we all know that. My heart is there, my life is there, and I will be there (soon). During my first year at UNC, I focused on Indonesia in a variety of classes or for papers. I wrote about Islamic Feminism in the context of Indonesia and studied the data from the DHS on family planning until I was sick of it. I was intrigued by the idea of Indonesia and how so many public health programs had been successful here. I thought it would be a great idea to see them in action and see how they could be transplanted or adapted to Mali/West Africa. I also kind of fell in love with the idea of Indonesia – the largest Muslim population, the sight of hundreds of beautifully decorated mosques, a country made up of thousands of islands, Bali – what wasn’t to fall in love with? I even talked to Baba about the possibility of moving to Indonesia and working here for awhile. He definitely didn’t love the idea, but I thought I needed to come see it to decide if the romantic idea of Indonesia in my mind matched the reality. It doesn’t for me, and no matter what happens here, I’m really happy that I know that. I miss the simplicity of Mali: the deserted highway from Bamako to Sevare with the exception of villages popping up here and there; the dusty roads traveling out to villages, the freedom to ride my bike anywhere and everywhere I want, and more than anything, the ability to connect and communicate with everyone and the openness and friendliness of – most – Malians. I don’t speak Bahasa Indonesian, and to be honest I really have no desire to. This pains me to say, as a devout Peace Corps volunteer, whose goal was to integrate into the community. Instead of listening to my Learning Indonesian podcasts and faithfully carrying around my Lonely Planet Phrasebook, I speak to most people in French and Bambara because in my mind, that’s what I should be doing in a foreign country. I don’t anyone here, with the exception of Anne, the woman I’m living with, a few staff at Jhpiego and my translator. And maybe it’s easier not to know anyone? Since I don’t have long term plans here, maybe it’s better not to get attached to anyone, I don’t know.
  

I'm definitely at a midpoint slump, and have marked every activity and deadline on my calendar until vacation in Bali and until I leave at August 2nd to return to Chapel Hill. So I ask, how long it too long or too short to be in a place? Obviously our internships couldn't be longer than 2 or 3 months, that's the nature of the academic schedule. But for me, without having more time invested in a place, and knowing that things will continue here status quo after I leave, and that my life is waiting for me in Chapel Hill, I don't feel motivated to invest in integrating here. Maybe it's the question of time, or maybe it's the question of where I am. I feel strongly that I would be motivated to integrate if I were in another West African country. I'm happy I'm in Indonesia right now, but I'll be happy to leave and continue my journey as a public health practitioner and advocate for women and children's health in West Africa.

Women in Bojonegoro know how to deliver in facilities

My favorite respondent in Bojon: She's 45 and her daughter was born 4 months ago. Her daughter's older siblings are 14 and 21. With this unexpected surprise, we can definitely say that family planning was needed in this household.

But she's SO adorable!

Two districts down, two to go. I was excited about our trip to Bojonegoro (which I’ll refer to as Bojon) because it meant flying to the opposite side of Java and seeing how this place runs it’s maternal and child health program. We flew into Surabaya, a large port city and the second largest city in Indonesia (and one of the largest red light districts in Asia, I just found out). We didn’t see the city, but started out to Bojon. Despite Google maps telling me it was 110 km and about 2 hours, it turned out to take 3 hours to get there. The road was good, part of the trip was on a toll road. The road after the toll road was quaint – it seemed like we were driving through small towns along the way, each had a beautiful mosque adorning the road side, most under construction of some sort. The other side of the road had a train track where several trains passed us, passengers hanging out of the doors probably trying to get a reprieve from the stifling heat inside. We arrived in Bojon after sunset, with a light rain and headed to the hotel. Pretty nice hotel, but infested with mosquitoes which required me to go on a killing spree before I could relax. The ceiling was too high, so I often stood on a chair, throwing something at the ceiling as I hurled myself off the chair. It took awhile, but I got most of them! I settled into an evening of CSI and NCIS reruns on TV.

The next morning, per usual, we went to the District Health Office to meet the staff, discuss our research and get their blessings. The women running the DHO were amazing – they knew all sorts of statistics about Bojon, which most other DHOs can’t give me. I was pretty immediately impressed. I found out the following:

• Bojon Population: 1.2 million

• 430 villages

• # of Public Hospitals: 3

• # of Private Hospitals: 6

• # of Puskesmas: 36

• # of Pustu (Assisted Puskesmas): 68

• # of Ponkesdes (a new facility we had not yet heard of: a facility with a midwife and a nurse): 100

• # of Polindes: 300

• % of women who use TBAs for delivery: 2

I also found out that between 2007 and 2010, there was an increase in MMR to 90 per 100,000, despite a reported facility-birth rate of over 70%. 70%? That’s amazing. Obviously this district is doing something right to ensure a facility-birth rate of over 70%. I felt like maybe we had come upon a district that, despite decentralization, was really paying attention to its women and children and not building bridges and roads with government money. This seemed like a really great start to our week.

A note here about Bojon’s definition of facility and the way we’ve defined facility for our research. They have included all of the facilities above (Hopsital, Puskesmas, Pustu, Ponkesdes and Polindes) in their 70%+ numbers. Our survey doesn’t include Ponkesdes, Polindes and really shouldn’t include Pustu either. None of these facilities have more than one provider (a midwife) in case of emergency or complication. That said, the Polindes that we found in Bojon were incredible. They were new, clean and well stocked with equipment and medicines. Much more so than some hospitals I’ve seen and certainly more than Polindes we’ve seen in other districts that amounted to no more than a small two roomed facility that had nothing inside of it. All this is to say that even though Bojon quotes this 70%+ number, we should still be able to find non-facility births, either at home or at these facilities that aren’t included in our research. After the first two days of visiting Polindes, where we should have found some non-facility births, but whose midwifes encouraged all the women to go to her private birthing center instead, we hadn’t found any. With this problem, we went to the DHO after we finished our interviews to discuss how to change our strategy of which villages to visit because we needed a certain number of facility, non-facility and pregnant respondents. When we reported to the DHO what had already happened, she yelled to her assistants to bring some documents to her. All of a sudden, the rate of facility-births in Bojon district was 94.7%, not the 70%+ that was quoted two days before. Okay, technically 95% is more than 70%, but there was definitely a problem in the way these numbers were presented to me and I was frustrated. Regardless, since the above mentioned facilities are part of the 95% number, but not part of our research parameters, that still meant that we should be able to find women that had delivered in these facilities, specifically any one of the 300 Polindes that I was told existed. The DHO staff seemed to think I was crazy and that I wasn’t for some reason understanding that we couldn’t find these women. I, at the same time, seemed to think they were crazy trying to push off a 95% facility-birth rate, while telling me at the same time that their MMR increased. To top it all off, my translator was driving me crazy by telling me that their numbers had to be correct, they had the data to back it up! She said she didn't believe it, but they had the data. Right, like data is never wrong. This comes from someone who is supposed to be helping me gather this research and later analyze the data. I told her I really didn’t care what their numbers and their data said, that the numbers didn’t jive. Over and over I was told, “Well, you’re not going to be able to find the numbers of non-facility women that you’re looking for,” while I repeated to them over and over that we needed about 23 non-facility women to interview. I could have probably backed down, but I was fighting for the statistical significance of my data (and my pride)! I’m not really sure how things worked themselves out in the end, since I was so pissed that I was being told that out of 400 non-facilities, I wouldn’t be able to find 23 women.

The first woman I saw feeding her child with a bottle. She is unable to breastfeed.

Quite the opposite of the woman above, this woman is overfeeding her baby to the point of obesity. This baby was only 3 months old and his mother had a hard time carrying him around. She reported that she was only feeding him breastmilk.

In the end, we wound up finding our women, though only 20 of them. Most of them had delivered at the Polindes, though there were a few home births mixed in there. We visited a variety of puskesmas, polindes and private midwives clinics. There was definitely an energy about the women in Bojon. They all seemed to have really good reasons for going to facilities, which means that someone is doing their job educating the women about the need to deliver in a facility. The women we found that delivered at home did so either because they didn't have money and didn't know about jampersal (the government policy to pay for births at facilities) or didn't make it to a facility in time.

Polindes in Mojosari

Delivery room at the polindes.

Actual trash cans outside of the polindes and along the road in this village

Village map in Sidobandung - green, yellow and red stickers all show where pregnant women live and classify them by normal, low-risk and high-risk pregnancies. The map is updated as women become pregnant.

Polindes in Ngunut: A map of the village including locations for the polindes, mosque, and showing rivers and bridges.

In the labor room at the polindes in Ngunut. I guess a rusty nail on the wall is as good as place to leave a stethascope

This is an emergency medical kit with essentials needed during labor and if there are minor complications. This one is quite empty, perhaps the reason that the midwife takes all the pregnant mothers to her pri

We conducted fewer interviews here than in the other two districts – only 68 compared with 82 and 74. For whatever reason, the situation at the DHO completely frustrated me and put quite a sour note on my week. Bojon made me feel completely over being in Indonesia and completely ready to go home. I’d never been happier to hear the words, “Welcome to Jakarta” from the airline pilot. I needed the comfort of my Jakarta house with swimming pool and good food before heading out to our last district: Serang.